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Flashcards in General Deck (201)
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1

What is Polycythemia Vera

is a rare type of blood cancer in which your body produces too many red blood cells.

2

Therapeutic phlebotomy is commonly used when patients have:

Polycythemia Vera

3

what is another word for phlebotomy?

venesection

4

How long should someone fast for lab work?

10-12 hours

5

where should the tourniquet be placed?

4-6 inches above the draw site

6

What should you use to clean the puncture site?

70% isopropyl alcohol

7

what is hemolysis

destruction of red blood cells

8

how long can a tourniquet be left on?

no longer than 1 minute

9

what causes hemoconcentration?

leaving the tourniquet on too long

10

_________ is when a competent person gives voluntary permission for a medical procedure after receiving adequate information about the risk of, methods, used and consequences of the procedure.

informed consent

11

_______ is permission given by the patient verbally or in writing for a procedure.

expressed consent

12

give two examples of implied consent

patient going to the emergency room or holding out an arm when told need to draw blood

13

_____ is when the patient's actions permits the procedure without verbal or written consent

implied consent

14

______ is special permission needed to administer a test that detects HIV

HIV consent

15

______ is permission given by a parent or legal guardian that permits procedures administered to underage patients

Parental consent for Minors

16

how do you identify a patient?

asking first name, last name, DOB or wrist band

17

what is a syncopal episode?

fainting

18

what is PPE?

Personal protective equipment

19

what are mucous membranes?

eyes, nose, mouth

20

what is barrier protection?

protective clothing (PPE) that provides a physical barrier against infection

21

if latex gloves cause skin allergies in patients what should be used?

vinyl or nitrile

22

the most commonly used personal protective equipment includes (5):

masks
goggles
face shields
respirators
gloves

23

the amount of personal protective equipment you wear is directly correlated to the:

amount of exposure you anticipate

24

____ in the lab is a direct OSHA violation

eating

25

What does OSHA stand for?

Occupational Safety and Health Administration

26

What does OSHA do?

to ensure safe and healthful working conditions for working people by setting and enforcing standards and by providing training, outreach, education and assistance.

27

T/F It is ok to recap needles

FALSE Needles should never be recapped

28

Where should needles be disposed?

Labeled sharps containers only

29

sharps containers should be locked and disposed of when they are ____ full as indicated on the outside of the container

2/3

30

What should you do if the sharps container is overflowing?

report the violation to the supervisor

31

broken glassware must be picked up by

mechanical means

32

decontamination can be accomplished by using (2):

a solution of sodium hypochlorite (bleach) and water at a ratio of 1:10
or
lysol or some other EPA-registered tuberculocidal disinfectant

33

when cleaning up a spill of blood on chairs, lab tables, or hard flooring what do you do?

carefully pour the 10% solution of bleach over the blood and leave it for at least 10 min

34

why do you leave the 10% bleach solution on blood spills for at least 10 min?

to ensure that any blood-borne pathogens are killed

35

If you are exposed to blood or any other potentially infectious material you should (4):

1. Wash the exposed area thoroughly with soap and running water.
2. Report the exposure to your supervisor as soon as possible
3. Refer to an MSDS
4. Fill out an exposure report form.

36

If blood is splashed in the eye or mucous membrane, flush the affected area with running water for:

at least 15 minutes

37

what is a MSDS

material safety data sheet

38

what is HBV

hepatitis B

39

there are ____ OSHA compliance inspections each conducted for a different reason

four

40

what are the four OSHA compliance inspections

1. Complaint inspection
2. the fatality/accidents inspections
3. the programmed inspection
4. the imminent danger inspection

41

_____ inspection occurs after an employees files a formal complaint with OSHA. It is the most common type of inspection.

Complaint inspection

42

_____ occurs after OSHA receives notice from the employer of a workplace fatality or an accident resulting in the hospitalization of three or more employees. OSHA also takes notice of media reports and will frequently investigate accidents that do not result in any fatalities or hospitalizations

the fatality/accidents inspections

43

______ is an inspection conducted of a randomly chosen workplace determined to be engaged in particularly hazardous types of work according to their standard industry classification (SIC) codes

programmed inspection

44

______ inspection occurs when OSHA receives a report that a condition of imminent danger exists in a workplace. This is the least common inspection type.

imminent danger inspection

45

venipuncture

The puncture of a vein, usually to withdraw blood or inject a solution.

46

vein selection is based on

the size and condition of the vein

47

Name the three major vein located in the antecubital fossa in order of preference:

median cubital
cephalic
basilic

48

this vein is most commonly used for venipuncture procedures. It is large and it does not tend to move when the needle is inserted.

median cubital

49

This vein can be more difficult to locate, however, it is the easiest vein to palpate in an obese patient.

cephalic vein

50

this vein is the least firmly anchored and located near the brachial artery. if the needle is inserted too deep you risk puncturing the brachial artery or a nerve

basilic vein

51

laboratory requisition

an order form that specifies what tests are being requested

52

accession number

a unique tracking number different for each sample

53

what is the solution that is becoming more commonly used as the primary antiseptic

chloraprep

54

what is the purpose of a tourniquet?

slows the venous outflow of blood from the arm causing the vein to bulge thereby making hem easier to locate

55

hemoconcentration

increased concentration of cells and solids in the blood usually resulting from loss of fluid to the tissues

56

tubes with additives must be _____ the appropriate amount of times in order to ensure proper mixing of blood and additive.

inverted

57

the _____ of a needle refers to the diameter or thickness of the needle

gauge

58

the lower the number of the gauge the ____ the needle,

larger

59

the larger the number of the gauge the ____ the needle

smaller/thinner

60

___ gauge is the larger/thicker bore and ___ gauge is small/thin

16, 23

61

needles smaller than ____ gauge are not recommended for drawing blood because they cause hemolysis.

23 gauge

62

needles smaller than 23 are not recommended for drawing blood because they cause ____.

hemolysis: the rupturing (lysis) of red blood cells (erythrocytes) and the release of their contents (cytoplasm) into surrounding fluid (e.g. blood plasma)

63

common needle size used for venipuncture is:

21 gauge

64

another name for "butterfly needle"

winged infusion set

65

Reasons to use a butterfly needle: (3)

-venipuncture on small veins such as those in the hand
-venipuncture procedures on elderly or pediatric patients
- needle phobic

66

entry with the butterfly should be at:

5 degrees

67

another name for needle disposal container

sharps container

68

When is it okay to recap a needle

never recap a needle whether it has a safety or not

69

true or false. It is necessary to disclose your level of experience to your patients

false

It is unnecessary to disclose your level of experience to your patients

70

true or false, if you have gloves on you do not have to wash your hands

false, always wash your hands

71

The patient should not pump their fist vigorously because:

it can affect some lab values such as potassium

72

Where do you place your thumb to anchor the vein?

place your thumb below the antecubital area slightly pulling the skin back

73

True or false, use a C shape to anchor your finger above the needle

FALSE never put your finger ahead of the needle

74

what direction should the bevel face?

facing up

75

insert the needle at a ____ angle when using a vac tube

15-30 degree

76

what does CLSI stand for?

Clinical and Laboratory Standards Institute

77

_____ guidelines state that the tourniquet should be removed as soon as blood flow is established rather that waiting until the last tube is filled.

CLSI

78

what is the proper way to dispose of a needle?

activate the needle and put it into a biohazard sharps container right away

79

What four things go on the specimen label?

patient full name, number identifier such as a DOB
date
time of collection
initials

80

what do you do if a specimen has been collected from the wrong patient?

immediately report the incident to the supervisor

81

the proper steps to end a blood draw (5)

remove the tourniquet
remove the tube
place gauze/cotton the site
remove the needle
activate the safety

82

name 5 factors that can influence a tough draw

hard to find veins
scarred and sclerosed veins
unconscious patient
rolling collapsing veins
quantity not sufficient

83

how do you help a needle phobic person (4)

use smaller needle
lay them down
conceal the needle and limit extended observation
cover tube filled with blood

84

Where are draws done on children under 2 years of age?

median cubital vein

85

how many attempts does a phlebotomist have to draw blood on a patient?

2

86

where do you draw in relation to an IV

below the IV

87

What is an edema?

an accumulation of fluid in the tissues

88

if your patient has had a mastectomy, where should you draw from?

avoid drawing from the associated arm (left mastectomy, no draws from left arm)
in case of double mastectomy draw blood from the foot if possible or consult the patient's nurse or physician

89

what is a fistula

a permanent surgical connection between an artery and a vein

90

True or false: It is ok to use a fistula to draw blood?

FALSE

91

What is a tortuous vein

winding or crooked vein and are susceptible to infection because blood flow is impaired. The sample may produce erroneous results.

92

what is the most common complication from phlebotomy?

hematoma: caused when the bevel of a needle is not completely in the vein and some blood releases into the tissue under the skin

93

what is the first thing you do if the patient faints?

remove the needle

94

what is vasovagal syncope

faint or experience dizziness before, during, or after venipuncture

95

true or false: when someone is experiencing vasovagal syncope you should put their head between their knees

FALSE. Never put their head between their knees as they can fall over and hit their head

96

what is a capillary?

a microscopic blood vessel

97

true or false: with a capillary collection always wipe away the first drop of blood with gauze

TRUE

98

where do you do a heel stick?

medial and lateral portions of the plantar surface of the foot

99

The American Academy of pediatrics recommends that heel puncture not exceed ___ mm for infants and ___mm for premies

2.0mm and 0.85mm

100

In a dermal puncture always ___ and never puncture deeper than ___ in an adult.

always wipe away the first drop of blood
never puncture deeper than 3.0mm in adult.

101

____ is a common test done on babies via heel stick

billirubin

102

When collecting bilirubin minimize exposure to light by:

collect in an amber tube
clear tube must be immediately protected from light by wrapping in foil or in a dark bag

103

what is hemostasis?

process by which blood vessels are repaired after injury

104

how many stages in hemostasis?

4

105

What are the four phases of hemostasis?

Vascular Phase
Platelet Phase
Coagulation Phase
Fibrinolysis

106

Which phase of hemostasis: injury to a blood vessel causes it to constrict, slowing the flow of blood.

Vascular Phase

107

Which phase of hemostasis: injury to the endothelial lining causes platelets to adhere to it. additional platelets stick to the site forming a temporary platelet plug in a process called "aggregation"

Platelet Phase

108

What are the two primary stages of hemostasis?

Platelet Phase
Vascular Phase

109

What test is used to evaluate the primary stages of hemostasis and when is it done?

Bleeding time test (BTT)
Performed prior to surgery

110

Which phase of hemostasis: this involves a cascade of interactions between coagulation factors that converts the temporary platelet plug to a stable fibrin clot.

Coagulation Phase

111

Which phase of hemostasis: the breakdown and removal of the clot.

Fibrinolysis

112

As tissue repair begins ____ (an enzyme) starts braking down the fibrin clot.

pepsin
plasmin
pepsinogen
plastin

plasmin

113

What are FDPs?

fibrin degradation products

114

what are fibrin degradation products used to monitor?

rate of fibrinolysis

115

Prothrombin time test (PT/INR) is used to evaluate the _____ pathway.

extrinsic

116

what does PT/INR stand for?

Prothrombin time/international normalized ratio

117

what does INR stand for?

international normalized ratio

118

What does PTT stand for?

Partial Thromboplastin Time

119

PTT is used to evaluate the _____ pathway.

intrinsic

120

What tube is used for the PTT or PT test? How much should it be filled?

light blue
completely filled

121

blood vessels, blood platelets and the coagulation factors all must be in working order for ____ to occur.

hemostasis

122

What is a device used in point of care testing (POCT) regarding PT/INR?

hemochron signature elite

123

what does POCT stand for?

Point of Care Testing

124

True or false the Hemochron Signature Elite is the industry standard for comprehensive point of care coagulation monitoring system

FALSE
practitioners may use an alternative

125

What is the basal state?

fasting, nothing by mouth and refrain from strenuous exercise for 8-12 hours prior to the blood draw.

126

Is water ok when basal state is required?

yes

127

whose responsibility is it to verify that the patient has followed the test guidelines?

the phlebotomist

128

what is post prandial?

after meal

129

What state should the patient be in and what tube is used for a lipid panel?

fasting state
SST tube

130

What step do you need to take if your facility allows patients to do a lipid panel unfasted?

mark on the tube that they were not fasting

131

the following are examples of what?
1. to measure blood levels of substances exhibiting dinural variation
2. to monitor changes in patients condition
3. to determine levels of medication in the bloodstream, therapeutic drug monitoring

timed specimens

132

What tube is required for testing digoxin?

red

133

What is digoxin?

a drug for cardiovascular disease

134

Blood is drawn to coincide with the ____ (lowest chemical blood level) and/or ____ (highest chemical blood level.

trough
peak

135

when are trough levels collected?

15 min before the scheduled pharmaceutical dose.

136

In therapeutic drug monitoring, it is essential for the lab to know what?

the time of the last dose when collecting blood

137

Regarding warmed specimens, how long must the tube be pre-warmed?

30 min

138

What methods are used to pre-warm tubes for warmed specimens?

incubator or chemical hand warmer

139

some tests require that the specimens be kept warm until:

the serum is separated from the cells

140

____ _____ are antibodies produced in response to mycoplasma pneumonia infection (atypical pneumonia).

cold agglutinins

141

Cold agglutinins must be collected in ___ tubes, pre-warmed in the incubator at ____ degrees for ___ minutes.

red-topped
37 degrees celsius
30 minutes

142

What is the proper way to chill a specimen?

slurry of crushed ice water

143

What is a common test that needs to be chilled and is drawn in a dark green tube?

ammonia

144

Wrap ____ specimens in aluminum foil immediately after the specimen is drawn. If available transport these samples in an ____ ____.

light-sensitive
amber bag

145

with stasis means:

with a tourniquet

146

without stasis means:

without a tourniquet

147

a lactic acid blood test must be drawn _____ stasis

without

148

True or False: a without stasis test can use a tourniquet to find a vein.

FALSE no tourniquet can be used.

149

Name three specimens that require chilling

ammonia
lactic acid
arterial blood gas (ABG)
Gastrin
glucagon
parathyroid hormone
Partial thromboplastin time
prothrombin time

150

The following tests require what special handeling?
ammonia
lactic acid
arterial blood gas (AGB)
Gastrin
glucagon
parathyroid hormone
Partial thromboplastin time
prothrombin time

chilling

151

Name three specimens that require warm collection and transportation.

cryoglobulin
cryofibrinogen
cold agglutinin

152

name three specimens that require protection from light

bilirubin
Vitamin B12
Vitamin B6
urine porphyrins
carotene
red cell folate
serum folate

153

name one specimen that requires a draw without stasis

lactic acid

154

True or false: some samples can be placed on dry ice

FALSE, never place samples on dry ice

155

__ __ is define as the skills and procedures prior to a specimen being analyzed.

pre- analytical phase

156

what is the most critical error a phlebotomist can make?

improperly identifying the patient prior to sample collection

157

what does OGTT stand for

oral glucose tolerance test

158

what hour windows are used for the OGTT?

1hr, 2hr, 3hr, 5hr

159

What is OGTT used to diagnose? (2)

diabetes mellitus and gestational diabetes

160

How much time dose a patient have to consume the glucola drink prior to a OGTT?

5 min

161

When is the first draw taken for OGTT?

before consuming the glucola

162

What is the first OGTT blood draw called?

basline test

163

a 3-hour OGTT will have how many blood draws?

4

164

a 5 hour OGTT will have how many blood draws?

6

165

for a OGTT how long should a patient fast prior to collection?

10-12 hours

166

__ ___ are ordered to detect the presence of microorganisms in the patient's blood

blood cultures

167

what does FUO stand for?

fever of unknown origin

168

_____ is a systemic infection associated with the presence of pathogenic organisms introduced during venipuncture. It is a bacterial infection spread through the entire vascular system of the body.

Septicemia

169

blood cultures are usually ordered

STAT
Warm
Chilled
Light protected
Timed specimen

STAT or Timed specimen

170

what does aseptic mean?

preventing infection

171

Blood cultures requires strict aseptic technique. This is done using ____

Chloraprep or its generic equivalent - chlorhexidine gluconate

172

Improper skin preparation for blood cultures is the most common cause of _____ when drawing blood cultures.

contamination

173

___ ___ are usually ordered in multiple sets from multiple sites at various times.

blood cultures

174

1 blood culture consists of ___ ___ bottles, ___ and ___

2 bottles anaerobic, 2 bottles aerobic

175

what does aerobic mean?

with oxygen

176

what does anaerobic mean?

without oxygen

177

when do coritosl levels peak?

around 8am

178

___ ____ are the daily cyclic variations of levels within the body during a 24-hour period

dinural variations

179

cortisol blood tests will be ordered and drawn between ____ and ____

8 and 10am
and midnight

180

what is PKU

phenylketonuria

181

PKU testing is done on blood from where on a newborn?

Or with what other kind of test?

heel (medial or lateral plantar surface)
urine

182

who usually draws a arterial blood gas test?

a respiratory therapist, nurse, or physician

183

a ABG sample must be run with in ____ of collection

15 min

184

what are the 4 primary tests performed on arterial samples?

pH, carbon dioxide, oxygen and bicaronate

185

When drawing an ABG it is imperative that nothing else takes place between the ____ and the ____.

collection
testing

186

____ is the liquid portion of un-clotted blood and still contains the clotting factors

plasma

187

____ is the liquid portion of the blood that has been allowed to clot.

serum

188

are there clotting factors present in serum?

no they have been allowed to clot

189

name the tubes with anticoagulants

lavender, green, pink royal blue with light blue stripe, light blue, and gray

190

lavender, green, pink royal blue with lt. blue stripe, light blue, and gray tubes will produce ____ when separated in a centrifuge

plasma

191

red, tiger top, gold tubes, speckled tubes and royal blue with a red stipe tubes will produce ___ when separated in a centrifuge.

serum

192

name the tubes without anticoagulants (3)

red, tiger top, and royal blue with a red stipe tubes

193

collecting specimens in the incorrect order of draw can result in

cross contamination

194

who has defined the order of draw to minimize cross-contamination?

CLSI, clinical laboratory standards institute

195

what tubes is chemistry responsible for? (5)

red
tiger top
mint green
dark green
gray

196

What tests can be done with a red tube top? (3)

serum pregnancy
digoxin
cold agglutinins

197

What causes a hematoma in regards to phlebotomy?

when the bevel of a needle is not completely in the vein and some blood releases into the tissue under the skin

198

The following tests require what special handling?

ammonia
lactic acid
arterial blood gas (AGB)
Gastrin
glucagon
parathyroid hormone
Partial thromboplastin time
prothrombin time

Chilling
Protection from light
Warm collection
Without stasis

Chilling

199

The following tests require what special handling?

cryoglobulin
cryofibrinogen
cold agglutinin

warm collection, 37 degrees C for 30 min

200

The following tests require what special handling?

bilirubin
Vitamin B12
Vitamin B6
urine porphyrins
carotene
red cell folate
serum folate

Chilling
Protection from light
Warm collection
Without stasis

Protection from light

201

Lactic acid specimens require what special handling?

Chilling
Protection from light
Warm collection
Without stasis

Without stasis